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Thursday, January 29, 2009

Ethics in Psychotherapy Part 3 - Training the Professional

It could be said that education in the United States of America is exceptionally diverse and perhaps even more so in the field of psychology. Among psychological programs at different American educational institutions, not only is there no national curriculum, there is often no uniform curriculum even within a particular state. Nevertheless, there are commonalities among psychological programs and all 50 states have some legislation to certify psychologists.

The regulation of professional psychology practice is necessary in order to insure that practitioners are qualified and can meet the affirmed professional and ethical standards. The licenses granted in the state of California are Licensed Psychologist, Licensed Clinical Social Worker (LCSW), and Marriage and Family Therapist (MFT). Each of these professionals is trained to understand human behavior, to recognize various emotional problems and disorders, and to provide therapy. In addition to the above mental health professionals who function as psychotherapists, there are other types of professionals who help people experiencing distress. Surprisingly, some of these professions require a license, certification or credential and some do not.

Education and Training of a Psychologist

Generally speaking, the aim of psychology is to reduce psychological distress, promote psychological well-being and to do no harm. If this is to occur, it is essential that the psychologist be competent. Competence is a legal, ethical, and clinical concept. Competency has been the subject of numerous studies and reports, as well as Supreme Court cases; it is worthy to note that our legal system makes the power of individual choice legally contingent on competence. Recognizably, judgments about competence are often discretionary, value laden, and culturally bound. Nonetheless, there must be some standardized strategy for determining not only competency for the individual therapist, but also for the programs used to train them.

Competent training programs should begin by maintaining adequate criteria for entrance into the program. In addition to the time-honored academic standards, trainee applicants should be evaluated for their attitudes of social responsibility, respect for cultural differences, and openness to learning. A thorough evaluation by a panel or admissions committee should seek to understand if the applicant has problems or personal attitudes that are likely to interfere with their participating in the training program, besides interfering with the practice of psychotherapy in particular. The trainee applicants should be asked to submit letters of recommendation from qualified professionals in the field, who can speak to their proficiency and suitability as a trainee and future professional-peer. In addition, applicants should be asked to write a comprehensive essay about their professional goals, including a self-assessment of their personal strengths and liabilities; it is essential for the trainee to have and demonstrate an adequate amount of self-awareness prior to working with clients/patients.

Moreover, the screening procedures should ideally be a two-way process. Not only should the program thoroughly screen potential applicants, applicants should be sifting through the training program information to be certain that the program will match their professional goals, and be a good personal fit in terms of mission, values and theoretical orientation. Obviously, the program should be clear about their mission statement, their values, the faculty and their background, the curriculum, academic expectations, and evaluation criteria, as well as informing applicants about the manner in which the education-training will occur. Just as it is appropriate and ethical for would-be clients to give informed consent prior to the start of therapy, a student should have a thorough understanding of the program prior to making a commitment. Furthermore, because most educational-training programs are in the business of recruiting students and showing themselves in their best light, a prospective student should make every effort to be in contact with other students already enrolled in the program or make contact with alumni that can perhaps offer a more objective view of the program in question.

Additionally, potential students should be ready with questions, which may include: What characteristics distinguish this program from others in the same field? What types of financial aid are offered? What is the relative importance of admissions test scores, undergraduate grades, recommendations, statements on applications, experience and other requirements? Does the program prefer applicants with work experience? Are there well-established advisors available to new students? What is the attitudinal temperature between faculty and students? What is the school culture in general? Are students in the program publishing and if so, where have they published? What are former students doing with their degree after graduation? As indicated above, it is essential that the potential student seek out other students in the program or former students in order to get a student prospective and a reasonably objective view. If the student enters a program and then finds the training to be ill-fitted to his or her professional goals, it is likely that neither party will thrive.

Qualification for CA Psychology Licensure

All things considered, having a degree in psychology (even a graduate degree), does not mean there has been adequate training to make one eligible for a professional license. In fact, there are many requirements for licensure and an applicant must be in compliance with all requirements before s/he will be considered for licensure. To begin with, an applicant must have earned a doctorate degree in psychology, education psychology, or in education with the field of specialization in counseling psychology or educational psychology. The degree must have been earned from an accredited university, college, or professional school. The applicant must have engaged in supervised professional experience under the direction of a licensed psychologist for at least two years (3,000 hours), with at least one year (1,500 hours) of experience following the award of the doctorate degree. Registration with the Board is required for everyone accruing supervised professional experience.

Certificate of Professional Qualification

The American Psychological Association's (APA) ethical code accentuates that training programs take reasonable steps to assure that program graduates meet requirements for licensure. Training requirements for licensure have been debated by members of the psychological community for many years. This is true in part because of the field of psychology demands a great deal from its trainees before certification will be authorized. Although the prerequisites to become a licensed psychologist are extensive, it seems reasonable given the ethical issues faced by these professionals every day, not to mention the potential for doing harm. Licensure and credentialing materials emphasize that applicants must evidence good moral character and psychological suitability to gain admission to the profession. In order to ensure the future of the profession, it is essential that psychology professionals possess more than ethical knowledge to practice ethically; they must also possess genuine virtues character. The psychology professional must maintain character traits such as integrity, honesty, forethought, and caring.

Procedures for Misconduct

There are many areas where ethical misconduct can be found in psychology. The first concern I personally encountered as a Practicum Trainee was in the area of confidentiality; incidents involving actual or potential risks of breaking confidentiality to third parties were plentiful. What's more, I continue to find the maintaining of client confidentiality challenging in my work with minors in school-based programs and mandated juvenile programs. The limits of confidentiality, although seemingly explicit, can become blurry within an agency setting and with certain populations. Having multiple experiences with other psychology professionals who were careless (e.g. leaving files on desks or saving progress notes on office computers with shared passwords) does not give me any warm fuzzy professional feelings, and in spite of bringing this issue to their attention, I cannot deny that this continues to be a frequent problem. In fact, it is very probable that the problem is largely unrecognized and/or significantly underestimated. While failing to maintain confidentiality may not fall into the category of most harmful, in terms of misconduct, it is an issue that raises much concern. Other areas that raise much unease and deserve close attention are the issues related to blurred, duel, or conflictual relationships.


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